By the later 19th century, the optimistic, humane reformism of scientific brain psychiatry was giving way to escalating fears of decline and degeneration. A common assumption among psychiatrists and numerous other medical thinkers was that the vertiginous changes induced by modern life had taken their toll on the nervous and mental health of the people. Filthy and overcrowded factories and domiciles were seen as the causes of a perceived explosion in mental illness in Europe's rapidly expanding urban centres, as reflected by heightened rates of suicide and staggering increases in the number of admissions to mental asylums. This alarmist atmosphere engaged the attentions of numerous doctors and social reformers by the early years of the 20th century. At this time, eminent psychiatrists dedicated their research to problems such as mental disease and deviance among the urban poor and apparent increases in alcoholism, criminality, suicide and vagabondage. While one psychiatrist pointed to 'extraordinary fruitfulness of the big city in producing mental illness,' others noted the disproportionate numbers of paralytics, alcoholics, epileptics, psychopaths and suicidals who inhabited Europe's crowded metropolitan areas. Psychiatrists as well as anthropologists, criminologists, social reformers and numerous other groups bemoaned these conditions and turned increasing attention toward preventive and eugenic measures in the years before World War I. (43)

c. 1900

By 1900, the rest cure had become the treatment of choice for neurasthenia everywhere, for those who could afford it. The nicest of the new open asylums, nerve clinics, and general sanatoriums now sprouting in many countries would customarily feature the Weir Mitchell treatment. (31)

c. 1900

Psychiatrists' vocabulary for describing psychiatric ailments had really been rather limited. Nerves, hysteria, and hypochondria were all holdovers from the 18th century and more or less interchangeable: hysteria for women who had psychosomatic complaints or who seemed emotionally incontinent; hypochondria approximately the same for men; and nerves for everybody who experienced depression, compulsive behavior, or anxiety. These were all considered functional nervous diseases, meaning that they were hypothetically organic but demonstrated no tangible tissue changes. (31)

c. 1900

For much of the last century, most cases of [anxiety disorders] would have been labeled as "hysteria." This word is derived from the Greek word for uterus. Since the condition [seemed to affect] mainly women of childbearing years, it was believed to be caused by a wandering uterus. (25)

c. 1900

Sigmund Freud, who had symptoms of anxiety disease himself, although not in a severe form, worried a great deal about his spells and had many medical evaluations for them. (25)

c. 1900

By the first decade of the twentieth century, without ever offering any clinical documentation of false complaints, Freud had concluded that his hysterical patients' accounts of childhood sexual abuse were untrue: "I was at last obliged to recognize that these scenes of seduction had never taken place, and that they were only fantasies which my patients had made up." ... Freud's recantation signified the end of the heroic age of hysteria. After the turn of the century the entire line of inquiry initiated by Charcot and continued by his followers fell into neglect. Hypnosis and altered states of consciousness were once more relegated to the realm of the occult. The study of psychological trauma came to a halt. After a time, the disease of hysteria itself was said to have virtually disappeared.
(40)

1902

Experimentation with low intensity electrical stimulation of the brain was first reported by Drs. Leduc and Rouxeau of France in 1902. Initially, this method was called electrosleep as it was thought to be able to induce sleep. (26)

1903

In 1903, the German chemist Emil Fischer and his collaborator Joseph von Mering modified a class of drugs originally synthesized in 1864 in a way that made them effective as sedatives and hypnotics. Fischer and Mering realized that their new drug, "diethyl barbituric acid," or barbital, was a sedative. It improved vastly upon the congeries of previous sedatives by not tasting unpleasant, by having few side effects, and by acting at therapeutic levels far beneath the toxic dose (unlike potassium bromide, which tasted awful and had a therapeutic level close to the toxic dose). (31)

1904

The Bayer company marketed Fischer's discovery [barbital] as "Veronal," the Schering company as "Medinal." Both brand names would become household words. The barbiturates were pricey. ... Veronal was first tried on patients in 1904 by Hermann von Husen, a young asylum psychiatrist who himself had problems sleeping. ... Veronal became the drug of choice in private nervous clinics (while the public asylums stayed with cheaper standbys such as bromium and chloral). (31)

1904

In 1904, two years after gaining his professorship, Paul Dubois published (in French) what was to become the most influential book on psychotherapy written before Freud. Dubois offered a highly rationalistic philosophy of "persuasion," using the doctor-patient relationship to persuade the patient to change his or her ways in a kind of Socratic dialogue in which medical advice constantly tugged patients toward betterment. (31)

1904

Though Russian physicians had observed [combat trauma] symptoms in the Siberian campaigns of the Russo-Japanese War of 1904, they remained largely unknown in Western European medicine. (43)

1905

The Russians were the first to post psychiatrists to the battle front. ... No one began keeping records on psychiatric casualties with any degree of precision until the Russo-Japanese War of 1904-5. ... Indeed, their attempts to diagnose and cure battle shock in 1905 represent the birth of military psychiatry. ...The first army in history to determine that mental collapse was a consequence of the stress of war and to regard it as a true medical condition was the Russian Army of 1905. ... Russian psychiatrists made very significant advances in clinically linking battle stress with a number of somatic symptoms. (30)

1907

The involuntary sterilization of mentally ill individuals began on American soil, where fears of being overrun by foreign immigration, disease and population degeneration took on particularly large dimensions. In 1907 the American state of Indiana pioneered legislation allowing the sterilization of the mentally ill and criminally insane. Over the next two decades, 27 other states and one Canadian province followed, with the result that some 30,000 people were sterilized, often involuntarily, by 1939. The American programme was actually a model for German eugenicists, who sought to enact similar legislation in Germany in the 1920s. (43)

1908

mental hygiene; an originally American initiative founded in 1908. Mental hygienists strove to intervene in the daily lives of 'normal' individuals, promoting measures to prevent the outbreak of mental diseases and to preserve society's productive capacity. Transmitting psychiatric teachings into schools, factories and offices, mental hygiene played a key role in shifting social and medical attention away from mental illness and onto mental health. (43)

1908

leading psychiatrists such as [Emil Kraepelin (1856-1926)] and Ernst Rudin (1874-1952) count among the early, adamant advocates of this growing tendency that sought to promote national health and fitness by intervening directly in the human reproductive process. Kraepelin proposed (and eventually oversaw) an extensive research programme concerning the heredity of the nervous and mental illnesses, and in 1908 Rudin became a co-editor of the Archiv fur Rassenhygiene (Archive of Racial Hygiene), the official organ of the eugenics movement in Germany. (43)

1908

a madly inspired German physiologist, Max Rubner, tried to determine [a scientific connection between stress and rate of aging]. He looked at all sorts of different domestic species and calculated things like lifetime number of heartbeats and lifetime metabolic rate. Such calculations lay behind ideas about why some species lived far longer than others. Soon the same sort of thinking was applied to how long different individuals within a species live. In general, Rubner's ideas about life spans among different species have not held up well in their strictest versions, while the "rate of living" hypothesis about individuals within a species that his ideas inspired have been even less tenable. Nevertheless, they led many people in the field to suggest that a lot of environmental perturbations can wear out the system prematurely. ... Rubner, M. 1908. Das problem der lebensdauer und seine beziehungen zun wachstum und ernahrun (Munchen: Oldenbourg). (41)

Dozens of other barbiturates came onto the market after the success of Veronal. In 1912, Bayer marketed Luminal (phenobarbital), a barbiturate still used for epilepsy. Because of its long-acting nature, "phenobarb" became a favorite drug in asylums well-off enough to afford it. "The prevailing anxiolytic," one elderly psychiatrist recalled, "was elixir phenobarbital. It was pink in color and many patients, most commonly female, carried their bottle of pink medicine with them and took a teaspoonful when necessary." (31)

1913

John B. Watson introduced "Behaviorism" which views psychology as a network of conditioned responses. In an experiment, he shows that a baby (little Albert (?)) is not afraid of numerous animals, but is conditioned to fear such animals when associated with a loud bang. Watson offers this as proof that fear is a learned, rather than inherited, trait. This contrasts with views of eugenics. In later years, Watson employs his ideas as an advertising executive (positive associations with products).

c. 1914

military psychiatry was not considered a legitimate field of study until World War I. (30)

The outbreak of World War I immediately produced large numbers of psychiatric casualties. Within Allied armies, military psychiatry was almost unknown as a functioning discipline and, more important, few Allied physicians knew or recalled the Russian experience with psychiatric casualties only ten years earlier. As a consequence, the medical establishments of the West thought they were dealing with an entirely new phenomenon in which "the present war is the first in which the functional nervous diseases (shell shock) have constituted a major medico-military problem." It was believed that most psychiatric cases were the consequence of new weapons, most particularly large-caliber artillery. Mental debilitation was widely believed to be caused by the concussive effects of shelling which produced a disruption in the physiology of the brain. Emotionally rooted explanations - such as fear and anxiety - were regarded as highly conjectural and never granted wide acceptance. (30)

c. 1914

In World Wars I and II, the Russian Army, in addition to providing vodka, administered a number of chemicals derived from plants to improve the fighting ability of their soldiers. Such natural drugs as valerian, a mild but effective tranquilizer, were given to soldiers to calm them. (30)

c. 1914

The frequency of contractive paralysis brought on by hysteria was relatively high, and French military physicians in World War I invented the technique of "torporlage" - administering an electric current to the paralyzed limb - to treat it. A similar technique for treating the same condition was used by German and Russian military physicians. (30)

c. 1914

The number of psychiatric casualties [during WW-I] was so great that hospitals had to be hastily requisitioned to house them. According to one estimate, mental breakdowns represented 40 percent of British battle casualties. Military authorities attempted to suppress reports of psychiatric casualties because of their demoralizing effect on the public. ... Initially, the symptoms of mental breakdown were attributed to a physical cause. The British psychologist Charles Myers, who examined some of the first cases, attributed their symptoms to the concussive effects of exploding shells and called the resulting nervous disorder "shell shock." (C. S. Myers, Shell Shock in France, 1940) The name stuck, even though it soon became clear that the syndrome could be found in soldiers who had not been exposed to any physical trauma. Gradually military psychiatrists were forced to acknowledge that the symptoms of shell shock were due to psychological trauma.
(40)

c. 1914

When the existence of a combat neurosis could no longer be denied, medical controversy, as in the earlier debate on hysteria, centered upon the moral character of the patient. In the view of traditionalists, a normal soldier should glory in war and betray no sign of emotion. Certainly he should not succumb to terror. The soldier who developed a traumatic neurosis was at best a constitutionally inferior human being, at worst a malingerer and a coward. Medical writers of the period describe these patients as "moral invalids." Some military authorities maintained that these men did not deserve to be patients at all, that they should be court-martialed or dishonorably discharged rather than given medical treatment.
(40)

c. 1914

Because these men were so militarily and economically valuable to the belligerent nations, doctors were under enormous pressure to treat and rehabilitate them. Early attempts at curing involved treatments derived from the somatic paradigm; consequently, doctors aimed to calm soldiers' nerves through soothing baths, massages and gentle rest cures which were often aided by sedatives and nutrient-rich diets. But these methods met with little success, and a mood of therapeutic pessimism prevailed in psychiatric circles. As the ranks of shell-shocked soldiers grew and the need for manpower escalated concomitantly, the taboos against psychological cures were gradually lifted. Consequently, a number of psychotherapeutic and suggestive techniques came into practice. These methods, which military-medical authorities called active treatment, varied significantly in accordance with doctors' particular styles and preferences; they included techniques that range from the familiar, such as hypnosis and electrotherapy, to the obscure, for example, faux operations, deception cures, phoney wonder drugs, or the placement of a metal ball on the larynx to induce a shriek in functionally mute patients. But these diverse techniques were united by their common basis in the principles of suggestion. (43)

1914

Walter Cannon was the first to use the word "stress" in a biomedical, rather than engineering, sense. (1914, "The interrelations of emotions as suggested by recent physiological researches," American Journal of Psychology 25, 256) ... [Cannon] formulated the well-known "fight or flight" syndrome to describe the stress-response, and he viewed it in a very positive light. His books, with titles such as "The Wisdom of the Body," were suffused with a pleasing optimism about the ability of the body to weather all sorts of stressors. ... Cannon was the first to recognize the role of epinephrine, norepinephrine, and the sympathetic nervous system. (41)

c. 1917

Progressive medical authorities argued [contrary to traditionalists] that combat neurosis was a bona fide psychiatric condition that could occur in soldiers of high moral character. They advocated humane treatment based upon psychoanalytic principles. The champion of this more liberal point of view was W. H. R. Rivers, a physician of wide-ranging intellect who was a professor of neurophysiology, psychology, and anthropology. His most famous patient was a young officer, Siegfried Sassoon, who had distinguished himself for conspicuous bravery in combat and for his war poetry. Sassoon gained notoriety when, while still in uniform, he publicly affiliated himself with the pacifist movement and denounced the war. The text of his Soldier's Declaration, written in 1917, reads like a contemporary antiwar manifesto. ... Rivers, by pursuing a course of humane treatment, had established two principles that would be embraced by American military psychiatrists in the next war. He had demonstrated, first, that men of unquestioned bravery could succumb to overwhelming fear and, second, that the most effective motivation to overcome that fear was something stronger than patriotism, abstract principles, or hatred of the enemy. It was the love of soldiers for one another. (40)

1917

In a famously fraught clinical encounter, the poet Siegfried Sassoon was treated for three months by the English neurologist and anthropologist W. H. R. Rivers at the Craiglockhart War Hospital near Edinburgh, where his fellow traumatized writers Robert Graves and Wilfred Owen were also housed. A second lieutenant, Sassoon had been a brave soldier who earned the Military Cross and the nickname 'Mad Jack' for his daredevil antics. He first got into trouble when, recovering from a war wound in 1917, he published 'A Soldier's Declaration', a pacifist treatise in which Sassoon characterized Britain's military conduct as a 'deliberately prolonged... war of aggression and conquest'. Instead of facing a military tribunal, however, Sassoon came into the hands of medical authorities. Diagnosed as a war neurotic, his anti-war sentiments were seen as evidence of mental illness, and he was sent to Craiglockhart in July of the same year. To counter this condition, which Sassoon never believed he had, Dr. Rivers applied a method loosely derived from psychoanalytic techniques, one that calls to mind the method first used in the case of Anna O. As in Breuer's case a quarter of a century before, Rivers' therapeutic strategy relied on catharsis; he sought to bring the symptoms' traumatic antecedents into the patient's consciousness, to discuss them and thus re-channel them in a healthier direction. After several months of treatment, Sassoon decided to return to service, not out of any political conviction, but out of concern for the men of his company. (43)

1918

End of WW-I.

c. 1918

Deafness of soldiers in modern wars has been recognized, at least since the end of World War I, as due far more often to hysterical conversion reactions caused by emotional turbulence than to physiological damage. During World War I, and before that in the American Civil War and the Franco-Prussian War of 1870, deafness in combat soldiers had been explained primarily as a function of concussion and contusion to the brain or eardrums caused by artillery fire. It was this belief which lead to the use of the term "shell shock" to explain a number of battle reactions which we know to be due to emotional turbulence. (30)

1918

The most prominent of the traditionalist view was the British psychiatrist Lewis Yealland. In his 1918 treatise, Hysterical Disorders of Warfare, he advocated a treatment strategy based on shaming, threats, and punishment. Hysterical symptoms such as mutism, sensory loss, or motor paralysis were treated with electric shocks. Patients were excoriated for their laziness and cowardice. Those who exhibited the "hideous enemy of negativism" were threatened with court martial. In one case, Yealland reported treating a mute patient by strapping him into a chair and applying electric shocks to his throat. The treatment went on without respite for hours, until the patient finally spoke. As the shocks were applied, Yealland exhorted the patient to "remember, you must behave as the hero I expect you to be... A man who has gone through so many battles should have better control over himself." (40)

1919

The idea that the mentally ill represented an enormous burden which, because they cost the state more than they contributed, did not deserve to live, was first articulated during World War I. In 1919 a German psychiatrist, Alfred Hoche, and Rudolf Binding, a law professor, wrote a tract defending taking the life of the incurably insane, an idea which resonated in Britain and North America as well. (43)

1920

"Prohibition" in the United States makes alcohol illegal from 1920 to 1933 (alcohol is now known to have both anxiolytic and anxiogenic effects).

c. 1920

Within a few years after [WW-I], medical interest in the subject of psychological trauma faded once again. Though numerous men with long-lasting psychiatric disabilities crowded the back wards of veterans' hospitals, their presence had become an embarrassment to civilian societies eager to forget.
(40)

c. 1920

The bogus medical procedure known as Radionics is thoroughly debunked in the 1920s by investigators from Scientific American magazine and other later investigations. Nonetheless, charlatans continued to sell such services to desperate patients throughout the 20th century.

1921

the major impact of chemical attacks is likely to be psychiatric. ... For example, a British Army study conducted in 1921 found that of the 600,000 Allied gas casualties in World War I, no fewer than 400,000 were psychiatric in origin or self-inflicted. (30)

In 1922 a young American psychiatrist, Abram Kardiner, returned to New York from a year-long pilgrimage to Vienna, where he had been analyzed by Freud. He was inspired by the dream of making a great discovery. "What could be more adventurous," he thought, "than to be a Columbus in the relatively new science of the mind." Kardiner set up a private practice of psychoanalysis, at a time when there were perhaps ten psychoanalysts in New York. He also went to work in the psychiatric clinic of the Veterans' Bureau, where he saw numerous men with combat neurosis. He was troubled by the severity of their distress and by his inability to cure them. In particular, he remembered one patient whom he treated for a year without notable success. Later, when the patient thanked him, Kardiner protested, "But I never did anything for you. I certainly didn't cure your symptoms." "But, Doc," the patient replied, "You did try. I've been around the Veterans' Administration for a long time, and I know they don't even try, and they don't really care. But you did."
(40)

1926

Although research on brain chemistry went back to the turn-of-the-century English physiologists, it was only in the early 1920s that Otto Loewi, professor of pharmacology at the University of Graz, isolated the first neurotransmitter. On the basis of work began in the winter of 1921, in 1926 he was able to say that the chemical acetylcholine mediated the transmission of the nerve impulse from one nerve to the next. (31)

1928

In Japan, Dr. Masatake Morita treats a case of panic disorder using a psychological technique called the "persuasion" method which is apparently similar to CBT. (18)

1929

Walter Cannon, a prominent physiologist who had been researching the bodily responses that occur in states of hunger and intense emotion. Cannon's research led him to propose the concept of an "emergency reaction," a specific physiological response of the body that accompanies any state in which physical energy must be exerted. According to Cannon's hypothesis, the flow of blood is redistributed to the body areas that will be active during an emergency situation so that the energy supplies, which are carried in the blood, will reach the critical muscles and organs. In fighting, for example, the muscles will need more energy than the internal organs (the energy used for digestion can be sacrificed for the sake of muscle energy during a fight). The emergency reaction, or "fight-or-flight response," is thus an adaptive response that occurs in anticipation of, and in the service of, energy expenditure, as is often the case in emotional states. The bodily responses that make up the emergency reaction were believed to be mediated by the sympathetic nervous system, a division of the autonomic nervous system (ANS). The characteristic bodily signs of emotional arousal - like pounding hearts and sweaty palms - were known in Cannon's day to be the result of the activation of the sympathetic division of the ANS, which was believed to act in a uniform way, regardless of how or why it was activated. (42)

1929

Walter Cannon was famous not only for his attack on William James' theory, but also for his own neural theory of emotion, which was based on research conducted in his laboratory by Philip Bard. Bard carried out a systematic series of lesion studies aimed at finding just what parts of the brain are required for the expression of rage. He made larger and larger legions, starting with the cortex and working his way down, until he found a pattern of destruction that eliminated rage responses. The critical lesion was one that encroached upon an area called the hypothalamus. In the absence of the hypothalamus, only fragments of emotional reactivity, rather than fully integrated reactions, could be mustered, and only in response to very intense, painful stimuli. The animals might crouch, snarl, hiss, unsheathe their claws, retract their ears, bite, and/or exhibit some autonomic reactivity, but these did not all occur together in coordinated fashion as they did when the hypothalamus was intact, and only very intense stimulations evoked the responses. Such findings suggested to Bard and Cannon that the hypothalamus is the centerpiece of the emotional brain. ... Although Cannon and Bard eliminated the cortex from the chain of events leading to emotional responses, they did not completely rule out a role for the cortex in emotion. In fact, Cannon and Bard felt that the conscious experiences of emotions, the feelings, depend upon the activation of the cortex by nerve fibers ascending from the hypothalamus. So in the absence of the cortex angry behavior is produced but is unaccompanied by the conscious feeling of rage. For this reason, Cannon used the term "sham rage" to describe the emotional outbursts of decorticate animals. (42)

c. 1930

In the 1930s, [Hans Selye] was just beginning his work in endocrinology. [During some experiments with ovarian extracts, he noticed that both the experiment and control rats developed peptic ulcers, greatly enlarged adrenal glands, and shrunken immune tissues. He inferred and later confirmed that these effects were due to stress (a term introduced by Walter Cannon).] What Selye did was to formalize the concept with two ideas: 1) The body has a surprisingly similar set of responses (which he called the "general adaptation syndrome") to a broad array of stressors, 2) Under certain conditions, stressors will make you sick. ... He developed a three-part view of how the stress-response worked. In the initial (alarm) stage a stressor is noted. The second stage (adaptation, or resistance) comes with the successful mobilization of the stress-response system and the reattainment of allostatic balance. It is with prolonged stress that one enters the third stage (exhaustion) where stress-related diseases emerge. Selye believed that one becomes sick at that point because stores of hormones secreted during the stress-response are depleted. It is not so much that the stress-response runs out; rather, with sufficient activation, the stress-response itself becomes damaging. (41)

1933

Plans for eugenic psychiatry - on the verge of realization when the Weimar Republic fell - became reality in Germany when the Nazis assumed power in 1933. In their attempts to form a genetically pure, racially healthy nation state, the Nazis immediately passed legislation calling for compulsory sterilization of large numbers of mentally and nervously ill, including schizophrenics, the severely alcoholic, the congenitally epileptic, and sufferers of 'congenital feeble-mindedness' (angeborener Schwachsinn in German terminology). Most of these operations were carried out in the law's first four years; the Nazi regime, in fact, sterilized as many as 400,000 patients between 1933 and the start of World War II in September 1939. Later in the 1930s, Nazi treatment of the mentally ill advanced to its next, unprecedently criminal phase in the so-called euthanasia programme, in which tens of thousands of psychiatric patients were brutally murdered. (43)

1935

Egas Moniz attended the Second International Congress of Neurology held in London in 1935. Here he audited a full-day symposium on the frontal lobes of the brain, then an object of great interest among many scholars. Moniz heard Carlyle Jacobsen and John Fulton from Yale describe the emotional changes in a chimpanzee following the ablation of much of its frontal lobes: Prone to temper tantrums and willfulness before the operation, the animal seemed to become almost cheery after it. "Dr. Moniz arose and asked, if frontal lobe removal prevents the development of experimental neuroses in animals and eliminates frustrational behavior, why would it not be feasible to relieve anxiety states in man by surgical means?" The inspiration for lobotomy, or leucotomy as Moniz called it, had been planted. (31)

1937

James Papez, a Cornell University anatomist, never specifically did research on emotion, but in 1937 he proposed one of the most influential theories of the emotional brain. ... [He speculated on neural pathways involved with emotional response in two ways; one via sensory stimulation of the hypothalamus, and the other via cortical stimulation and feedback of the hypothalamus.] ... The Papez circuit was a brilliant piece of anatomical speculation, as most of the anatomical paths proposed had not been identified at the time. Remarkably, almost all of them exist. With very few modifications, a set of connections closely resembling the Papez circuit has been found. Unfortunately, at least for the Papez theory of emotion, this circuit appears to have little involvement with emotion. Nevertheless, the Papez circuit theory is a crucial part of the history of the emotional brain, and it was the takeoff point for the limbic system theory. (42)

1937

1937 was a banner year for the emotional brain. Not only was the Papez theory published then, but so too was the first in a series of reports by Heinrich Kluver and Paul Bucy. These investigators were involved in the study of the brain regions that mediate drug-induced visual hallucinations when they stumbled upon a remarkable set of observations on the effects of damage to the temporal lobes of monkeys. ... They referred to this collection of symptoms as "psychic blindness," by which they meant that the animals had perfectly good visual acuity but were blind to the psychological significance of stimuli. ... This work had a significant impact on several areas of brain research, including the search for the brain mechanisms of visual perception, long-term memory, and emotion. But the impact of most relevance to us at the moment was its influence on Paul MacLean and his limbic system theory of the emotional brain. (42)

1938

Relaxation. This can be accomplished by gradual, conscious, controlled muscle relaxation, first propounded by E. Jacobson in Progressive Relaxation (1938). (48)

1938 Apr

electroconvulsive therapy [(ECT)], which Ugo Cerletti, professor of psychiatry in Rome, used for the first time in April 1938. Although the history of psychiatry had known many previous applications of electricity, Cerletti's historic innovation was giving electric shock to the brain to achieve a convulsion. (31)

c. 1940

Dr. Mandel Cohen and his colleagues at Harvard Medical School found that some patients with severe anxiety often had intolerance to over-exercising. ... It seems that for some reason these people either overproduced lactate and were unable to handle it chemically, or their bodies were abnormally sensitive to it. (25)

c. 1940

Soviet soldiers in World War II were routinely given drugs made from herbal compounds to calm their nerves. (30)

c. 1941

In 1941 Kardiner published a comprehensive clinical and theoretical study, The Traumatic Neurosis of War, in which he complained of the episodic amnesia that had repeatedly disrupted the field: "The subject of neurotic disturbances consequent upon was has, in the past 25 years, been submitted to a good deal of capriciousness in public interest and psychiatric whims. The public does not sustain its interest, which was very great after World War I, and neither does psychiatry. Hence these conditions are not subject to continuous study ... but only to periodic efforts which cannot be characterized as very diligent. In part, this is due to the declining status of the veteran after a war. ... Though not true in psychiatry generally, it is a deplorable fact that each investigator who undertakes to study these conditions considers it his sacred obligation to start from scratch and work at the problems as if no one had ever done anything with it before." ... Kardiner went on to develop the clinical outlines of the traumatic syndrome as it is understood today. His theoretical formulation strongly resembled Janet's late nineteenth-century formulations of hysteria. Indeed, Kardiner recognized that war neuroses represented a form of hysteria, but he also realized that the term had once again become so pejorative that its very use discredited patients: "When the word 'hysterical' ... is used, its social meaning is that the subject is a predatory individual, trying to get something for nothing. The victim of such a neurosis is, therefore, without sympathy in court, and ... without sympathy from his physicians, who often take ... 'hysterical' to mean that the individual is suffering from some persistent form of wickedness, perversity, or weakness of will."
(40)

c. 1941

With the advent of the Second World War came a revival of medical interest in combat neurosis. In the hopes of finding a rapid, efficacious treatment, military psychiatrists tried to remove the stigma from the stress reactions of combat.
(40)

c. 1941

By the entry of the United States into World War II, psychoanalysis had captured the basics of training in psychiatry at the undergraduate and graduate level. ... The psychiatrists who went marching off to cure combat fatigue during the war were armed with psychoanalytic doctrine. (31)

c. 1941

The U.S. government deliberately censored news and films about battlefield traumas -- and continued to do so for years after the war was over. ... Battlefield censors routinely purged reporters' dispatches of information about war neurosis, malaria and other unpleasant details. Graphic accounts and photos of injury were often sanitized for fear of demoralizing the home front: The 1977 book "Life Goes to War," for instance, contains not a single photograph of dismembered corpses. And for the most part, war correspondents rarely balked at these restrictions. John Steinbeck recalled in a memoir that "the foolish reporter who broke the rules would not be printed at home and in addition would be put out of the theater by the command." It was not, Steinbeck said, "that the correspondents were liars," but that "it is in the things not mentioned that the untruth lies." (45)

1942

During the onset of the Nazi blitzkrieg bombings of England, London was hit every night like clockwork. Lots of stress. In the suburbs the bombings were far sporatic, occurring perhaps once a week. Fewer stressors, but much less predictability. There was a significant increase in the incidence of ulcers during that time. Who developed more ulcers? The suburban population. ... Ulcers and bombings in World War II: Stewart, D., and Winser, D. 1942. "Incidence of Perforated Peptic Ulcer: Effect of Heavy Air-Raids." Lancet (28 February), 259. (41)

1942

Walter Cannon contacted a variety of missionaries, anthropologists, and medical people working in the third world, collecting their descriptions of voodoo death in order to decide that it sounded like too much sympathetic nervous system to him (1942, "Voodoo Death," American Anthropologist 44, 169). (41)

1942 Oct

The success of combat psychiatry can be traced to the efforts of one man, Capt. Frederick R. Hanson. Born in the United States and trained as a neurologist and neurosurgeon, Hanson had been working in Canada when the war broke out. He joined the Canadian Army and served in its psychiatric hospital in England, where he studied and learned from the experiences of the Allies. When the United States entered the war, he transferred to the U.S. Army. ... By the opening of the battle for Tunisia, Hanson's ideas had matured. Psychiatric casualties were to be held in a hospital close to the front and were to be diagnosed with the term "exhaustion," borrowed from the British Eighth Army. It described pretty well the way the patient actually felt, encouraged him to believe that he could recover with rest, and removed the stigma of mental illness. Some psychiatrists complained that "the term had nothing to do with the accepted lingo of their specialty, but that was probably one of its advantages."
(46)

1943 Aug 3

The Seventh Army commander, Lieutenant General George S. Patton, Jr., held views that were very similar to many high ranking commanders of the time. On August 3, 1943, Patton paid a visit to the 15th Evacuation Hospital near Nicosia. On this day in the admitting tent he happened upon a Private who had recently arrived with a diagnosis of "psycho-neuroses anxiety moderate/severe." The diagnosis meant more or less the symptoms or his current condition. As a matter of fact, the diagnosis was wrong: The man was later found to be running a high fever, and the hospital's ultimate diagnosis would be chronic dysentery and malaria. When Patton stopped and asked what was wrong with him, the private replied miserably, "I guess I can't take it." At this the general lost his own self-control. Patton berated the man, slapped his face with his gloves, seized him, and threw him out of the tent. An enlisted medic picked the patient up and took him to a ward. Back at his headquarters, Patton noted in his diary, "I gave him the devil, slapped his face with my gloves and kicked him out of the hospital.... One sometimes slaps a baby to bring it to." He then issued a memorandum to his subordinate commanders, warning them that "a very small number of soldiers are going to the hospital on the pretext that they are nervously incapable of combat. Such men are cowards.... Those who are not willing to fight will be tried by Court-Martial for cowardice in the face of the enemy." (46)

1943 Aug

A week later Patton visited the 93d Evac on another mission to cheer the wounded. In the receiving ward he found a patient shivering on his bunk with a diagnosis-in this case accurate-of severe shell shock. When Patton questioned him the man began to sob, saying, "It's my nerves, I can hear the shells coming over, but I can't hear them burst." "What is this man talking about?" Patton demanded. "What's wrong with him, if anything?" Then he called the patient "a coward." He slapped him hard and repeatedly, threatened to have him shot, and waved his pistol in the man's face. The hospital commander, who had entered the tent, had to step between Patton and his victim before the attack ended. These incidents reflected the traditional prejudices and lack of understanding of what is combat fatigue. Yet the problem of how to deal with psychiatric casualties remained. In the face of excessive losses caused by the evacuation of combat exhaustion cases, the old school of thought reluctantly changed, but only as a result of the need to conserve manpower. The army began to make serious efforts to save its psychiatric casualties as functioning soldiers. (46)

1944

In 1944, the physiologist Geoffrey Harris proposed that the brain was also a hormonal gland, that it released hormones that traveled to the pituitary and directed the pituitary's actions. ... lots of scientists thought Harris's idea was bonkers. [By the 1970s, he was finally proven right by Guillemin and Schally.] (41)

1944

In a study of American soldiers assigned to a combat division in France in 1944, over half admitted that they became sick to their stomachs, felt faint, lost control of their bowels (thus the old adage, "scared shitless"), or broke out in cold sweats during battle. (30)

1944

In World War II, American fighting forces lost 504,000 men from the fighting effort because of psychiatric collapse. ... In every one of America's wars in this century the rates of psychiatric collapse among soldiers have exceeded the number killed in action. ... Psychiatric casualties constituted the single largest category of disability discharges in World War II. (30)

1944

One soldier, describing his first panic attack in 1944 almost forty years later, could still recall the time of day and location of the attack, what he was doing at that moment, and who he was with. Five months before, he had participated in one of the first troop waves to land on the Normandy beaches on D-Day. He said the anxiety he felt landing on the beaches was mild compared to the sheer terror of one of his panic attacks. (25)

1944

For much of military history, psychiatric breakdown in war has been conveniently dismissed as the isolated acts of cowards or the weak, a view which was generally held in the US military up through World War II. ... [This belief] has led the military for most of this century to adopt a model of psychiatric breakdown which is grossly incorrect. ... World War II saw the first large-scale systematic use of recruit screening for psychiatric disposition to mental collapse. ... The results of this screening were disappointing. ... despite the attempt to eliminate the "weak" from the military manpower pool, psychiatric casualties were admitted to military hospitals at twice the World War I rate... Psychiatric breakdown has nothing to do with being "weak" or cowardly. ... There is no evidence to support the commonly held view among the civilian populace, fostered by movies and television programs, that only the weak or the cowardly break down in battle. ... The rates at which soldiers become debilitated suggest quite strongly that psychiatric breakdown is precisely what normal men do when the strain becomes too great. (30)

1944 Mar

In March 1944 an experiment was tried in the 3d Infantry Division at Anzio. Psychiatric casualties were heavy after a winter of siege; the beachhead remained all front and no rear, so that even support troops were subjected to much the same dangers as riflemen and suffered breakdowns under the stress. Captain Joseph Robert Campbell, a "decisive and firm" medical officer with much combat experience, set up a unit staffed by himself, a line officer, and seven enlisted medics to treat psychiatric casualties. The mood was entirely non-hospital; the unit was attached to the division's engineer battalion, and its program featured rest, physical work, and therapy. Campbell returned 66 percent of his psychiatric cases to duty. He also evaluated disciplinary cases from the stockade, returning about one-third of them to duty as well. So promising was the success rate that-in another step forward for combat psychiatry-treatment at division level later became the rule in the Italian campaign." (46)

1945

psychiatrists Roy Grinker and John Spiegel, noted that the situation of constant danger lead soldiers to develop extreme emotional dependency upon their peer group and leaders. They observed that the strongest protection against psychological breakdown was the morale and leadership of the small fighting unit.
(40)

c. 1945

The treatment strategies that evolved during the Second World War were designed to minimize the separation between the afflicted soldier and his comrades. Opinion favored a brief intervention as close as possible to the battle lines, with the goal of rapidly returning the soldier to his fighting unit. In their quest for a quick and effective method of treatment, military psychiatrists once again discovered the mediating role of altered states of consciousness in psychological trauma. They found that artificially induced altered states could be used to gain access to traumatic memories. Kardiner and Spiegel used hypnosis to induce an altered state, while Grinker and Spiegel used sodium amytal, a technique they called "narcosynthesis." As in the earlier work on hysteria, the focus of the "talking cure" for combat neurosis was on the recovery and cathartic reliving of traumatic memories, with all their attendant emotions of terror, rage, and grief. ... The psychiatrists who pioneered these techniques understood that unburdening traumatic memories was not in itself sufficient to effect a lasting cure. Kardiner and Spiegel warned that although hypnosis could expedite the retrieval of traumatic memories, a simple cathartic experience by itself was useless. Hypnosis failed, they explained, where "there is not sufficient follow-through." Grinker and Spiegel observed likewise that treatment would not succeed if the memories retrieved and discharged under the influence of sodium amytal were not integrated into consciousness.
(40)

1946

It was recognized for the first time that any man could break down under fire and that psychiatric casualties could be predicted in direct proportion to the severity of combat exposure. Indeed, considerable effort was devoted to determining the exact level of exposure guaranteed to produce a psychological collapse. A year after [WW-II] ended, two American psychiatrists, J. W. Appel and G. W. Beebe, concluded that 200-240 days in combat would suffice to break even the strongest soldier: "There is no such thing as 'getting used to combat.' ... Each moment of combat imposes a strain so great that men will break down in direct relation to the intensity and duration of their exposure. Thus psychiatric casualties are as inevitable as gunshot and shrapnel wounds in warfare." (JAMA, 1946)
(40)

The National Mental Health Act, authorized the Surgeon General to improve the mental health of US citizens through research into the causes, diagnosis, and treatment of psychiatric disorders.
(22)

1946

In the United States, there would be no national regulation of psychiatric care until after World War II. ... The National Institute of Mental Health [would eventually be] created by the Mental Health Act of 1946.
(31)

1947

American psychiatrists focused their energy on identifying those factors that might protect against acute breakdown or lead to rapid recovery. They discovered once again what Rivers had demonstrated in his treatment of Sassoon: the power of emotional attachments among fighting men. In 1947 Kardiner revised his classic text in collaboration with Herbert Spiegel, a psychiatrist who had just returned from treating men at the front. Kardiner and Spiegel argued that the strongest protection against overwhelming terror was the degree of relatedness between the soldier, his immediate fighting unit, and their leader. (40)

1948

Page and colleagues isolate serotonin from blood for the first time. (10)

The National Institute of Mental Health (NIMH) was established in response to mental health problems suffered by veterans of World War I and II. (21, 31)

1949

Research on the neural basis of emotion was interrupted by World War II. But things began to pick up steam again in 1949 when Paul MacLean revived and expanded the Papez theory, integrating it with the Kluver-Bucy syndrome and with Freudian psychology. ... MacLean pursued the hypothesis, and a very radical one at the time, that psychiatric problems might be attributable to disorders of the visceral brain, and particularly that the visceral brain might be the source of pathology in patients with psychosomatic symptoms. (42)